African American cancer patients, as compared to White counterparts, continue to initiate treatment later and remain less apt to undergo complete treatment; fueling worse treatment outcomes including shorter survival. The concepts of transparency and accountability, as mechanisms of systems change have been applied for decades by anti-racism organizations to civil rights and social change. Yet, the application of these concepts to health systems' change and unequal treatment has rarely been done. Objective: The Greensboro Health Disparities Collaborative and two Cancer Centers have joined together to specify structures built into cancer care systems that make cancer care vulnerable to institutional racism and investigate how they can be changed to reduce racial inequity in quality and completion of treatment for Stage 1-2 breast and lung cancer patients. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) systems change intervention is informed by CBPR principles, the Undoing RacismTM framework, and findings from our preliminary studies. Methods: ACCURE has 2 transparency components and 2 accountability components, hypothesized to reduce racial inequities in completing treatment of early stage breast and lung cancer : 1) Analysis of Power and Authority for patients to voice their feedback on pressure points encounters during treatment that undermine quality and completion of cancer care; 2) Healthcare Equity Training + booster sessions for providers on the relevance of institutional racism to cancer care; 3) Monthly Clinical Performance Reports delivered by a Physician Champion to clinicians and their teams on race-specific, quality of care data for their patients + suggestions for improving care; and 4) a specially trained ACCURE Navigator to provide a 2-way communication bridge for hearing and responding to patients. To assess the separate and combined effects, in real time, from the intervention on completion of treatment, we propose a 5-year interrupted time series, with an embedded, 3-year randomized control trial, study design. Potential Impact of findings are to: help define meaningful use requirements for health IT, established by national policy-making bodies; contribute to the American College of Surgeons Rapid Quality Reporting System; and, ultimately, create sustainable change within systems of care. Our systems approach has the potential to optimize transparency of and accountability for racial equity in completing treatment in 1500 cancer centers affecting 1.4 million cancer patients annually. PUBLIC HEALTH RELEVANCE: Persistent inequities experienced by African American cancer patients while in treatment demand a diligent and bold response. Yet, few prospective studies have identified systemic causes for less than optimal cancer care for African Americans and even fewer show effective interventions. ACCURE proposes to accomplish both of these goals through a 4-year intervention to optimize transparency and system accountability for racial equity in the completion of treatment for early stage breast and lung cancer.